As curves flatten throughout Canada, businesses and schools re-open, and social distancing measures are relaxed, many Canadians are enjoying the return to normal daily routines. However, for people who struggle with various forms of anxiety, the thought of re-engaging may result in feelings of dread.
For a portion of people with anxiety, the experience of lockdown came as a bit of a relief and was associated with peace and quiet. The pressure to be out of the house and socializing was removed and some people with elevated anxiety were relieved to comply with government recommended avoidance. Now, those who were initially relieved may experience anticipatory anxiety. For example:
- What if I have a panic attack and throw up in public? It will be embarrassing and people may think I have the virus.
- It’s been such a long time since I’ve seen anybody, what will I talk about?
- What if people come too close to me? I won’t be able to tell them to move back, and if I do, it might cause a fight.
- What if I get the virus when I continue my daily routine?
People may have become comfortable inside for a variety of reasons:
- If you typically have found social situations to be anxiety-provoking or panic-inducing (e.g., What if I say or do something embarrassing? What if others think I’m boring or stupid?), being asked to “go home and stay home” may have been music to your ears, like a welcome “pause”
- If you had a history of illness fears or concern about being responsible for making someone else sick, you will have likely heeded the direction to stay home and been happy to do so
Anxiety and fear are normal human emotions and they can be helpful and adaptive in that they prevent us from making choices that are actually dangerous or ill advised. However, when anxiety or fear becomes frequent or occurs in the absence of an actual threat, it can become problematic.
A common sense response to feeling anxiety or fear is to immediately stop or reverse the situation that may be causing the problem. For example:
- If you are in a grocery store and begin to feel anxious, leave your cart and exit the store
- If you are feeling nauseous at the thought of speaking up at a meeting, call, in sick etc.
Although escape or avoidance may feel like the right thing to do, it is usually the exact opposite approach to take when one’s fear is out of proportion to the actual danger. Strategies that lessen anxiety in the short term often make it worse in the long term.
For example, if you left the grocery store because your heart was racing and you thought that a catastrophe was about to occur, the next time to you went into a store you might be on guard and be mindful of your heart. This anticipatory anxiety might result in you noticing physical sensations and misinterpreting them as signs of trouble that could lead to heightened anxiety or panic.
Although it makes sense in the short term, avoidance or escape from anxiety only serve to maintain it.
As people overcome anxiety, a couple of things happen:
- First, you learn that you are overestimating the probability of something bad happening
- Second, you learn that you are underestimating your ability to cope if something were to go wrong
As mentioned earlier, strategies that make anxiety better in the short term usually make it worse in the long term. Well, the reverse is also true – anything that makes anxiety worse in the short run will usually make it better in the long run. Putting yourself in situations that bring on anxiety may not make logical sense, but it is exactly what you need to do. We are not suggesting that you go immediately back to what you were doing before the pandemic struck –instead, take a measured approach to get yourself back into activities outside of your home.
Here are some guidelines and principles to follow as you gradually return to your daily routine:
1. Perhaps most importantly, continue to follow public health guidelines.
Note that the degree and rate of reopening may vary across the country. Stay informed when restrictions are reinstated, depending on the course of the virus and its spread, and stay up to date as the availability of testing, treatments, and vaccines over time.
2. Make decisions in accordance with local public health guidelines and not your anxiety.
As reopening continues, your public health authority may make suggestions that conflict with your internal sense of safety. Put your trust in your local public health officials. Although safety is almost never a guarantee, if your local public health officials have provided the guidelines, use them and not your internal feelings of fear of anxiety to tell you what you can and cannot do.
3. Remind yourself of the reasons to re-engage.
Doing things that you have not done in a while will likely be anxiety provoking and difficult at times. Before you start or before you do something you know might be particularly difficult, it would be a good idea to remind yourself of what can be gained by doing the things that the anxious part of you is saying could be risky. Sources of motivation may include:
- Modelling bravery for your kids
- Being outside together as a family to build positive memories
- Not letting anxiety push you into a corner
4. Identify what you fear could happen and challenge those fears before you start.
The anxious part of your brain will say things like: “don’t do this, it could be risky,” “what if you make a fool of yourself,” “what if it’s dangerous,” “what if you contract the virus and bring it back to your family? You will be responsible for bringing it into the house and they will never forgive you.”
In response, identify the specific fears or thoughts you may experience and challenge them before you enter a situation so you can rely on your reasoned conclusion while you are in a potentially anxious spot.
5. Start small.
Not everything that you avoid or are anticipating re-entering is equal in terms of difficulty. It is a good idea to start small – at a level that you are pretty sure you could do but haven’t yet tried. Give yourself a chance to succeed. Think of it a bit like the high jump; better to set the bar at a lower level and clear it by a long shot compared to setting high and running into it. If you set yourself up to succeed, it will build a sense of confidence and a desire to push forward.
To start, build a fear ladder to help yourself progress to more challenging situations.
6. Gradually work up to more difficult situations.
Give yourself a chance to build on your success by gradually increasing the difficulty level.
For example: Slowly approach going to the grocery store at closer to peak times. Although it may be time consuming, it also may help you gather data to refute the anxiety-provoking predictions regarding the danger level of being out of the house.
7. Mix and match the situations that produce anxiety.
Sometimes when people try to get past a fear, the situations in which they test it will be relatively narrow (e.g., only going out for walks between 6:00 and 7:00 in the evening). Although this is a decent first step and better than always staying inside, it doesn’t give you much information regarding the extent of the perceived threat.
To put yourself in a better position to gather information, it is a good idea to vary the situations (e.g., going out all times of day) and if possible to combine situations that make you anxious (e.g., taking the elevator from the parking garage with a person who is not a member of your family [if the posted signs allow for it] to get to the grocery store where you had planned to shop)
8. Be consistent.
Like any fear, the more often you confront it, the quicker you will reach a place of comfort with it.
For example: Imagine two people who have the same fear (e.g., walking by people on the street because of a concern that they might get the virus). One person goes out once a day for 15 minutes and the other person goes out once a week for 15 minutes. The first person will have gotten much more experience and gathered much more data that would help them to refute their anxiety provoking predictions compared to the second person.
9. Debrief yourself after doing something that makes you anxious.
After you finish doing something that scares you, compare what actually happened to what you feared could happen. In some cases, you may not be able to do this debrief with yourself until several days later. For example, if you make a prediction that going outside and walking on the street and passing others will make you sick, compare it to what actually happened but recognize that it might take up to two weeks to get an answer. In other situations, you may be able to do a debrief immediately after completing a scary activity. For example, if you go outside with a mask on and make a prediction that people will point, stare and ridicule you for wearing a mask, you will be able to immediately debrief with yourself, comparing your prediction to the actual outcome. Hopefully over time you will collect a number of experiences that may demonstrate that you are overestimating the threat/danger, which may help the next situations to not seem so scary.
10. Don’t negate your success.
The anxious part of your brain has a job – to keep you safe from danger. Of course, if we always listened to this part of our brains, we would not have a happy or productive life because too much time would be spent expecting danger and trying to keep safe. If you gradually approach anxiety-provoking situations and have success, expect that the anxious part of your brain will try to take away from the success (e.g., “you got lucky”, “the people you passed today looked healthy.” “people felt sorry for me, which is why they didn’t get upset with me,” etc.).
Don’t let yourself negate success. While it is true that initial forays out into the world after being locked away don’t provide definitive information on health and safety, own your success and understand that the more you do it, the more information you will have to make accurate estimations.
11. If something is more difficult than you expected, be compassionate with yourself and don’t give up.
Moving past a fear is rarely all forward movement. The phrase, “two steps forward, one step back,” is a more accurate representation of what the work looks like when people try to overcome something they fear.
When (not if) you do have a moment(s) of difficulty around an anxiety-provoking exercise, give yourself some encouragement for doing something that is hard, and think about what you might tell a cherished friend. Hopefully, you would not be critical of that friend but rather lead with kindness while encouraging a regroup followed by another attempt. Remember, if you have not been successful with something, it’s an opportunity to learn from it so the next attempt has a greater likelihood of success.
12. Congratulate yourself for your hard work.
Facing a fear is hard work. It does not matter if others don’t share your fear. We all have things that scare us and because of this, it is best for us to be our own yardstick. Compare within yourself. If you are working hard to overcome your fear, you deserve to congratulate yourself. Speed does not matter (remember the fable of the tortoise and the hare?). Also, don’t fall into the trap of congratulating yourself for a positive outcome. If you focus on the effort you are putting in and you are following the above guidelines, trust that the outcome you want will come. It may not be as quick as you would like, but it will come. The work of re-entering the world after an unprecedented months-long lockdown is work. If you are trying to overcome your fears, then you deserve to congratulate yourself for you hard work!
Thanks to Dr. Martin Antony and Scientific Advisory Committee member Dr. Maureen Whittal, for creating this resource.